Midwives – The Lowdown

Midwives – The Lowdown, NHS or Independent what are the pro’s and con’s?

Midwives are trained pregnancy and childbirth care professionals, available in the UK through the NHS or independently.

In the UK, midwifery-led care has become the norm, and midwives are generally responsible for the care of all low-risk patients – and some of them care for high-risk patients, too. This has freed up a lot of time for obstetric consultants, who are now reserved for specialist pregnancy and labour care.

But how do you know what kind of midwife to choose? With independent midwifery clinics springing up across the UK, it can be a difficult choice to make. In this article, we will attempt to make this choice a little easier for you.

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Hospital vs Home Birth: The Role of Midwives

When you’re planning for your baby’s birth, you’ll have lots to think about. One of the main thoughts that will be going through your mind will be the midwives that will attend your birth – after all, along with your birth partner(s), they will be your main companions throughout your labour.

If you decide to plan to give birth to your baby at home, you may be wondering if your care will differ at all to that of mothers giving birth in a hospital environment.

Ultimately, the main job of midwives is to keep you and your baby as safe as possible, but the dynamics between midwives and their patients can be quite different at a home birth than at a hospital birth.

Hospital Birth
Hospital maternity units are run to strict protocols to ensure quality of care for every woman and baby on the unit. Additionally, maternity units are generally very busy places – often, midwives are stretched to their limits. As a result, midwives need to be ‘in charge’ of their unit. The dynamic between midwives and mothers on a maternity unit is usually very much that of professionals and patients, although midwives do their very best to empower women to make their own choices about their births.

If you choose to give birth on a hospital maternity unit, you will be assigned to a midwife when you arrive. They generally won’t be able to stay with you throughout your labour, but will check on you regularly. When it comes to the second stage of labour when your baby is born, you will have two midwives with you, or a midwife and a doctor.

Home Birth
A home birth is usually a much more holistic affair than hospital birth. People who opt for home birth usually do so because they want a more natural experience, or because they want to feel more in charge of their birth. At a home birth, the midwife – mother dynamic is quite different. Midwives acknowledge that they are guests in the mother’s home, and as such, the mother is very much in charge of her own birth. The midwives are there to safeguard the mother and facilitate the safe delivery of the baby.

If you choose to give birth at home, two midwives will attend you. Usually, the first midwife will arrive at your home with the equipment, and then send for the second midwife when the second stage of labour is approaching.

It is important that we point out that the legal requirements of midwives are the same whether you give birth at a hospital or at home – as the patient, your care is centred around you, and wherever you give birth you are legally responsible to make decisions about your care. The only real difference between hospital and home births is how the birth experiences feel to the birthing family.

How to Choose Independent Midwives for a Home Birth

Independent midwives are becoming a popular choice among pregnant families. Many mothers feel safest in the hands of midwives who do not have to deal with the problems of understaffing in NHS hospitals, and prefer the more personal approach.

Independent midwives are generally most popular amongst women who want as natural a birth as possible. Childbirth is seen as an important rite of passage by many women, so it’s understandable that they wish to hire midwives whose ideals mesh with their own.

So, how do you go about choosing your midwives? Here are some of the things you would want to consider.

What are their perinatal mortality and morbidity rates?

Perinatal mortality and morbidity are the statistics that you should be concerned with when choosing your midwives. The terms cover death or serious injury in late term pregnancy, during birth and the immediate postpartum period. Of course, some deaths cannot be avoided, but you will want to know whether their statistics are within normal ranges.

What is their transfer rate?

Many people who are hoping for a home birth will look for the midwives with the lowest transfer rate. A low transfer rate is good for those who are seeking a natural home birth, but you should also look at this number in conjunction with their perinatal mortality rates. A low transfer rate coupled with a higher than average perinatal mortality rate is a sign that you should run for the hills.

What are their feelings towards natural birth?

If it is important to you to have a natural birth – and if you’re seeking a home birth, that’s most probably the case – you will want to be in the hands of midwives who believe in natural birth as much as you do. Finding a balance is hard sometimes as midwives are medical professionals first and foremost – their primary concern is your health, and the health of your baby. You cannot expect professional midwives to agree to attend a home birth if the risk of danger to you or the baby is too high. Of course, your eligibility for home birth will depend on many factors such as any previous pregnancy complications, your distance from the hospital and how many children you have had. Again, balance is the key. Try to find midwives who are passionate about, and trust in natural birth and its benefits, without being too dismissive of the fact that sometimes complications occur despite all our hard work in preparing.

What happens if you need to transfer?

You will need to know what happens if you end up having to transfer to hospital. Will your midwives accompany you? And in what capacity will they accompany you? Usually, they will accompany you in the capacity of a doula (a labour and post-partum support person) but you will need to check this before the birth.

What happens if your midwives aren’t available?

Babies rarely come when they are expected to, and sometimes emergencies will crop up that mean your midwives won’t be available to attend your birth. Make sure that they have a contingency plan. Usually there will be many midwives within a private practice, but make sure that there will always be somebody available to come to you.